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gen path final > Liver, GB, pancreas > Flashcards

Liver, GB, pancreas Flashcards

1
Q

how can the liver respond to injury?

A

1) degradation of hepatocytes
2) Necrosis
3) Inflammation
4) regeneration
5) Fibrosis

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2
Q

An excess of ______ causes Jaundice. what blood concentration must be reached for diagnosis?

A

Excess bilirubin

> 2.0 mg/dl

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3
Q

what is the etiology of jaundice?

A

overproduction of blilrubin, reduced hepatocyte uptake, & obstruction of bile flow

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4
Q

____________ are the number 1 cause of jaundice

A

Hemolytic anemias

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5
Q

what is the difference between unconjugated, and conjugated, bilirubin?

A

Unconjugated-virtually insoluble, toxic

Conjugated-soluble, nontoxic

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6
Q

what is icterus?

A

yellowing of the sclera

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7
Q

what is the definition of hepatitis?

A

hepatocyte injury that is associated with inflammation

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8
Q

what are the etiologies of hepatitis?

A

hepatotrophic viruses
autoimmune
drug
toxic agents

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9
Q

Hepatitis ________ infections are characterized as: Benign, self-limited infection, no chronic or carrier state

A

Hepatitis A

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10
Q

How is Hepatitis A transmitted? what is the incubation time? What type of virus is it?

A
  • RNA virus
  • Fecal or oral transmission
  • Incubation 2-6 weeks
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11
Q

Hepatitis B is caused by what type of virus? how is it spread? what is the incubation time?

A

DNA virus
Parenteral / sexual spread
Incubation 30-180 days

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12
Q

what are the 3 types of Hepatitis B infections?

A

Carrier, chronic, cirrhosis

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13
Q

what type of cancer can be caused by hepatitis B?

A

Hepatocellular carcinoma

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14
Q

T/F: most infections of Hepatitis B lead to cirrhosis or chronic hepatitis

A

FALSE

95% are self-limiting

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15
Q

what are the “hallmark” features of Hepatitis C?

A

Persistent infection + chronic hepatits

found in 85% of cases

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16
Q

what virus type is Hepatitis C? whats its incubation time?

A
  • RNA virus
  • majority of infections progress
  • Incubation 7-8 weeks, acute phase asymptomatic
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17
Q

why is there no available vaccine for hepatitis C?

A

Hepatitis C has a lot of genomic instability

keeps mutating

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18
Q

what are the histological characteristics of an ACUTE viral hepatitis infection?

A

Panlobular disarray, Inflammation, Hepatocyte necrosis

condition resolves in 8 weeks

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19
Q

which hepatitis strains are most likely to cause a “Fulminant “?

(Fulminant = mass liver necrosis, results in acute liver failure)

A

** Hepatitis C

  • Hep B can also cause it
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20
Q

what is the definition of chronic hepatitis?

A

Abnormal liver function for >6 weeks

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21
Q

Hepatitis B induced liver disease is an important precursor for _________

A

HCC

hepatocellular carcinoma

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22
Q

what determines the ultimate outcome for Hepatitis B?

A

Host immune response

Hepatocyte damage likely reflects CD8+ cytotoxic T cell damage to Hepatitis B infected hepatocytes

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23
Q

an infection with Hepatitis ____ does not increase liver enzymes such as serum aminotransferases

A

Hepatitis G

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24
Q

the pathology of autoimmune hepatitis is associated with what?

A

T-cell mediated autoimmunity

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25
Q

Alcoholic liver disease is caused by the overlapping of what 3 conditions?

A

1) hepatic steatosis (fatty liver)
2) EtOH hepatitis
3) cirrhosis (fibrosis + nodules)

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26
Q

what condition is associated with “Mallory” bodies in the liver?

A

fatty liver (from alcoholism)

AND

alpha-1 trypsin defeciencies

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27
Q

what are mallory bodies?

A
  • clumps of cytokeratins

- eosinophilic

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28
Q

______________ is the most common non-alcohol fatty liver disease

A

Metabolic liver disease

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29
Q

in cases of cirrhosis, there will be histological evidence of bridging ______

A

septae

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30
Q

what are the symptoms of Portal hypertension from cirrhosis?

A

Ascites

Collateral venous channels

Splenomegaly

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31
Q

what causes hemochromatosis ?

A

1) excess Iron: accumulation in liver, pancreas, heart

2) genetic

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32
Q

what is the most common type of genetic hemochromatosis?

A

most common is Homo-zygous recessive

  • mutation on Chromosome 6
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33
Q

what is the morphology of hemochromatosis?

A

Hemosiderin

Fibrosis

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34
Q

name the “classic triad” associated with hemochromatosis

A

1) micronodular cirrhosis
2) diabetes mellitus
3) skin pigmentation

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35
Q

what causes Wilson’s disease? what organs does it effect?

A

A) Autosomal RECESSIVE disease

B) results from a failure to incorporate copper (Cu) into ceruloplasmin

C) Copper accumulates in liver, brain, eyes

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36
Q

what is the clinical presentation for Wilson’s disease?

A
  • acute or chronic liver disease. May present with tremor or behavioral changes
  • presents between 6 to 40 years of age
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37
Q

what is the treatments for Wilson’s disease?

A

1) Chelation

2) D-Penicillamine (immunosuppressive drug)

38
Q

why can a serum screening for concentrations of Copper (Cu) NOT be used to diagnose Wilson’s disease?

what should be used instead?

A
  • serum levels may actually be low

- instead use Cu levels in urine (good for screening) or Cu levels in liver (definitive diagnosis).

39
Q

what develops from an alpha1-antitrypsin deficiency?

A
  • develop pulmonary emphysema from protein degrading enzymes

- Also develop liver disease

40
Q

Intrahepatic Biliary Tract Disease includes what 3 conditions?

A

1) secondary biliary cirrhosis
2) primary biliary cirrhosis
3) primary sclerosing cholangitis

41
Q

_____________ cirrhosis results from obstruction of extrahepatic duct

A

Secondary biliary cirrhosis

42
Q

what are the risk factors for Cholesterol stones and Pigment stones?

(Cholelithiasis risk factors)

A

Cholesterol:

  • caucasians
  • age
  • females (increased estrogen)

Pigment:

  • hemolysis
  • blood disorders
  • biliary dysfunction
43
Q

what is Primary biliary cirrhosis (PBS)? what does it affect?

A

Inflammatory autoimmune disease

affects intrahepatic bile ducts

44
Q

what is the primary feature of PBS?

primary biliary cirrhosis

A

nonsuppurative inflammatory destruction of medium sized intrahepatic ducts

45
Q

what are the characteristics of Primary sclerosing cholangitis (PSC)?

A
  • Fibrosing cholangitis of bile ducts
  • develop luminal obliteration
  • Liver eventually develops biliary cirrhosis
46
Q

T/F: Primary biliary cirrhosis, secondary biliary cirrhosis, AND Primary sclerosing cholangitis all have the SAME endpoint

A

true

47
Q

what are the characteristics of Cholangiocarcinomas?

A

Cholangiocarcinoma = Adenocarcinoma of gallbladder

  • arises in bile ducts within and outside the liver
  • VERY aggressive, asymptomatic till late stage
48
Q

what are the histological characteristics for hepatocellular adenomas?

A

bland hepatocytes and no bile ducts

49
Q

______________ is the 3rd leading cause of cancer deaths worldwide

A

hepatocellular carcinoma

50
Q

what are the etiological factors for hepatocellular carcinoma?

A

chronic viral infection (HBV, HCV)
chronic alcoholism
NASH (nonalcohol steatohepatitis)
food contaminants (primarily aflatoxins).

51
Q

what form of Hepatocellular carcinoma is more likely to form in young men and women?

A

Fibrolamellar Carcinoma

52
Q

T/F: Fibrolamellar carcinomas have a worse prognosis than hepatocellular carcinomas

A

FALSE

better prognosis for fibrolamellar

53
Q

Fibrolamellar carcinomas are associated with “________ tumors” meaning they form hard masses with fibrosis

A

“Scirrhous” tumor

54
Q

what type of hepatic cancer is generally fatal within 6 months of diagnosis?

A

Adenocarcinoma of gallbladder

  • AKA Cholangiocarcinoma
  • poor prognosis due to insidious onset
55
Q

what are the 2 primary soft tissue sites for metatases to occur in the body?

A

liver and lungs

they get the most blood

56
Q

why is hepatomegaly usually the only sign of a malignant cancer in the liver

A

liver has a massive functional reserve

it can sustain a lot of damage without showing clinical signs

57
Q

T/F: men are more likely to develop Cholelithiasis (gall stones) than women

A

FALSE

  • women are twice as likely to have them
58
Q

what factors increase the formation of cholelithiasis (gall stones)?

A
  1. Increased with estrogen (pregnancy and oral contraceptives)
  2. Increased with gall bladder stasis
  3. Hereditary contribution
59
Q

while 70-80% of patients with gall stones remain asymptomatic, what are the possible symptoms when they occur?

A

A) develop colicky biliary pain
B) may eventually note perforation
C) obstruction of gall bladder or erode into ileum
D) develop GI obstruction

60
Q

_____________ Almost always occurs in association with gallstones

A

Cholecystitis

inflammation of the gall bladder

61
Q

what are the clinical symptoms of ACUTE Cholecystitis?

A

** Severe Right Upper Quadrant pain

Chemical, bacterial, reflux-ischemia

MOs later in course

62
Q

what are the types of cholecystitis?

A

Cholesterol (85% radiolucent)

Bilirubin (50-75% radiopaque)

63
Q

what 3 conditions cause pigmented gall stones (cholecystitis)?

A

Hemolysis

GI disorders

Biliary infection

64
Q

T/F: chronic cholecystitis is usually associated with vague symptoms, and fibrosis/inflammation of the gall bladder

A

true

65
Q

what group is at the highest risk for Gall bladder Adenocarcinomas?

A

70 years old

Whites > blacks

F > M

66
Q

95% of adenocarcinomas of the gall bladder are associated with __________

A

gallbladder stones

67
Q

what are the endocrine functions of the pancreas?

A

regulates glucose homeostasis via insulin & glucagon

68
Q

what are the exocrine functions of the pancreas?

A 
A) critical for food digestion
B) Pancreatic enzymes include:
- amylase
- trypsin & chymotrypsin
- lipase
69
Q

what 3 conditions are responsible for 80% of all Acute pancreatitis cases?

A

Cholelithiasis (gall stones)
Biliary Tract Disease
Alcoholism

70
Q

what is the definition of pancreatitis?

A

reversible parenchymal injury associated with inflammation

71
Q

what is the MAIN clinical symptom of pancreatitis?

A

ABDOMINAL PAIN

“upper back intense pain”

72
Q

why is severe pancreatitis a medical emergency?

A

due to potential of pancreas to release toxic enzymes

73
Q

what enzymes are elevated during pancreatitis?

A

1) Amylase

2) Lipase

74
Q

what occurs during chronic pancreatitis?

A

Progressive destruction exocrine pancreas, later stages lose endocrine

75
Q

what are the possible causes of chronic pancreatitis?

A
  • Alcoholism
  • Biliary disease
  • Hypercalcemia
  • Hyperlipidemia, Oxidative stress
76
Q

what are the morphological features of chronic pancreatitis?

A 
Reduced acini 
Chronic inflammation
Fibrosis 
Obstruction ducts 
Spare islets
77
Q

why is a serum test for amylase levels NOT good for diagnosing chronic pancreatitis?

A

disease may have already destroyed acinar cells, so may not see an increase in serum amylase

78
Q

Close to 95% of Pancreatic cystic neoplasms arise in what population group?

A

women

79
Q

most carcinomas of the pancreas of are what type?

A

Adenocarcinomas

makes sense- its a gland

80
Q

Pancreatic Exocrine Tumors are the _____ leading cause of cancer death in the U.S.

A

4th

lung, colon, breast, pancreas

81
Q

what is the precursor lesion for pancreatic cancer?

A

pancreatic intraepithelial neoplasias

AKA- “PanINS”

82
Q

what age group is most likely to develop pancreatic cancer?

A

60-70 year olds

83
Q

T/F: most patients diagnosed with pancreatic cancer die within 6 months

A

TRUE

  • has “silent growth” and is usually not identified until advanced stages
84
Q

____________ doubles the risk of developing pancreatic cancer

A

smoking

85
Q

besides smoking, what are the 2 other risk factors for pancreatic cancer?

A

diabetes mellitus

chronic pancreatitis

86
Q

what is the precursor lesion for pancreatic carcinomas?

A

pancreatic intraepithelial neoplasias

AKA- “PanINS”

87
Q

what age group is most likely to develop pancreatic carcinomas?

A

60-70 year olds

88
Q

T/F: most patients diagnosed with pancreatic carcinomas die within 6 months

A

TRUE

  • has “silent growth” and is usually not identified until advanced stages
89
Q

carcinomas in which portion of the pancreas will cause jaundice?

A

head of pancreas

  • they can block common bile duct
90
Q

which strains of hepatitis can transition into “carrier states”?

A

Hepatitis B, Hepatitis C

91
Q

what is the result of Fulminant formation due to Hepatitis?

A

results in acute liver failure

this is rare

92
Q

___________ is the 12th most common cause of death in the U.S.

A

Cirrhosis

  • primary reason for death = liver death

gen path final (8 decks)

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